In another blog, we mentioned that one billing practice that raises red flags for insurers is using the same code over and over for multiple patients. The truth is, ICD-10 codes are a departure from older diagnostic coding systems. And limiting yourself to a single code presents problems for both the insurer and the patient. Here are some reasons why:
You might be accustomed to relying on what are known as “pain codes.” These are ICD-9 codes that refer to the patient’s actual complaints during consultation. But the problem with handling diagnoses in this fashion is that you’re only describing symptoms. Treating symptoms does not necessarily result in increased wellness. ICD-10 codes are meant to encourage and enable best practice when it comes to diagnosis and billing. As a result, ICD-10 works best when you’re choosing codes that address the root cause of a problem.
The new ICD-10 codes are specific enough that they need to be used together to paint clear “portraits” of individual patients. The use of a single code can come across as inaccurate simply because it’s monochromatic. If it were a painting, a single code would be Snow White in a snowstorm. When that’s all you submit, insurers worry that you’re not investigating deeply enough when you diagnose a patient, or that you’re not understanding the importance of clearly communicating with insurers. Use multiple codes to provide a detailed rendition of your patient’s needs.
There’s an even bigger issue to think about: non-specific codes can cause confusion because they don’t seem to justify the services the patient receives. Whether you recommend additional procedures, referrals, or prescriptions, if the code you’re using doesn’t seem to reflect your reasoning, you’re cruising for a denial of reimbursement. Underusing ICD-10 codes denies patients services.
Another important factor to keep in mind that individual physicians aren’t islands unto themselves. You are one link in the chain of providers that serve any given patient. The codes you choose will help other healthcare professionals glean insights and draw conclusions about the next steps they should take. There are even “cause codes” that explain how and where an injury occurred. An inaccurate or non-specific code can lead to misdiagnosis and even the implementation of inaccurate therapies. The right code opens a dialogue between the initial physician and specialists.
The goal, obviously, is not to simply pile on additional codes, but rather to thoroughly document a patient’s condition and serve as a valuable participant in the dialogue between providers. By understanding how to apply ICD-10 codes in combination with each other, and implementing them as they were designed to be used, you streamline patient care, billing, and reimbursement.